The number of Americans with diabetes continues to increase, according to CDC's most recent National Diabetes Fact Sheet. So does the number of Americans with prediabetes, a condition that increases their risk of type 2 diabetes, heart disease, stroke, kidney disease, foot complications or Neuropathy, eye complications, skin complications, depression and gingivitis disease or tooth and bone loss. States with the largest increases over the 16-year period were Oklahoma, up 226 percent; Kentucky, up 158 percent; Georgia, up 145 percent; Alabama, up 140 percent, Washington, up 135 percent, and West Virginia, up 131 percent, according to the study published in CDC's Morbidity and Mortality Weekly Report.

Beta cells, which are found in the pancreas within tiny cell clusters called islets, are the body’s sole source of the essential hormone insulin. Diabetes is characterized by the bodies in ability to produce and/ or respond appropriately to insulin, and results in the inability of the body to absorb and use glucose as a cellular fuel. These defects result in a persistent elevation of blood glucose levels and other metabolic abnormalities, which, in turn, lead to the development of disease complications.

The most common forms of diabetes are Type I diabetes, in which the immune system launches a misguided attack, destroying the beta cells of the pancreas, and Type 2 diabetes, in which the body becomes resistant to insulin signaling, with subsequent impaired insulin production. While the causes of beta cell loss or failure differ, all major forms of diabetes share a common bond in the pancreatic beta cell.

This is particularly important in light of studies that show that adverse changes in both the micro- and macro vascular environments can occur up to 10 years prior to diagnosis.

Understanding Your A1c

Because your sugar level can change from hour to hour, we required you to test your blood four time per day (daily A1c). A test that sums up how much glucose has been sticking to part of the hemoglobin during the past 3–4 months. Hemoglobin is a substance in the red blood cells that supplies oxygen to the cells of the body

If you have diabetes, you may know about the A1C test that tells you your average blood glucose over the past 2 to 3 months. A1C is reported as a percent (for example, 7%). Now we have a new way to report A1C called estimated average glucose, or eAG. eAG uses the same units (mg/dl) as your glucose meters.

Why use eAG?
Using eAG may help you get a better idea of how well you are taking care of your diabetes. And that can help you and your health care provider know what changes you may need to make to be as healthy as possible.

A1c test and calculatorThe table to convert Hb-A1c to Mean Plasma Glucose (MPG) is based on the following formulas:

Study finds some insulin production in long-term type 1 diabetes
Massachusetts General Hospital (MGH) research has found that insulin production may persist for decades after the onset of type 1 diabetes. Beta cell functioning also appears to be preserved in some patients years after apparent loss of pancreatic function. The study results appear in the March issue of Diabetes Care.

A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose comes from carbohydrate foods. It is the main source of energy used by the body.

HBA1c

<5.7 %

A test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.

Insulin

2-8.4 µlU/mL

Insulin is normally secreted by the beta cells (a type of islet cell) of the pancreas. The stimulus for insulin secretion is a HIGH blood glucose...it's as simple as that! Although there is always a low level of insulin secreted by the pancreas, the amount secreted into the blood increases as the blood glucose rises. Similarly, as blood glucose falls, the amount of insulin secreted by the pancreatic islets goes down.

The regional distributions of iron, copper, zinc, magnesium, and calcium in parkinsonian brains were compared with those of matched controls. In mild Parkinson's disease (PD), there were no significant differences in the content of total iron between the two groups, whereas there was a significant increase in total iron and iron (III) in substantia nigra of severely affected patients.

Although marked regional distributions of iron, magnesium, and calcium were present, there were no changes in magnesium, calcium, and copper in various brain areas of PD. The most notable finding was a shift in the iron (II)/iron (III) ratio in favor of iron (III) in substantia nigra and a significant increase in the iron (III)-binding protein, ferritin. A significantly lower glutathione content was present in pooled samples of putamen, globus pallidus, substantia nigra, nucleus basalis of Meynert, amygdaloid nucleus, and frontal cortex of PD brains with severe damage to substantia nigra, whereas no significant changes were observed in clinicopathologically mild forms of PD.

In all these regions, except the amygdaloid nucleus, ascorbic acid was not decreased. Reduced glutathione and the shift of the iron (II)/iron (III) ratio in favor of iron (III) suggest that these changes might contribute to pathophysiological processes underlying PD.

A small number of immune response genes have been consistently associated with the common autoimmune conditions. Recently, a linkage disequilibrium (LD) mapping approach, using tag single nucleotide polymorphisms (SNPs), identified genetic association between type 1 diabetes (T1D) and the interleukin-2 receptor alpha (IL-2Ralpha)/CD25 gene region on chromosome 10p15. Because certain autoimmune diseases, such as autoimmune thyroid disease (AITD) and T1D cluster together in certain families, we sought to determine if the TID-associated CD25 region was also associated with Graves' disease (GD).

Adiponectin

5.2-13.1 µg/mL

Adiponectin (Ad) is a hormone secreted by adipocytes that regulates energy homeostasis and glucose and lipid metabolism.

Type I Diabetes:
Type I Diabetes is caused by an autoimmune disorder-a problem with the body's immune system. In a healthy body, specialized cells (called beta cells) in the pancreas make insulin. Insulin is a hormone that allows the body to use energy from food. In Type I Diabetes, the immune system mistakes beta cells for invaders and attacks them. This results in loss of pancreatic function and inability to produce insulin. When enough beta cells are destroyed, symptoms of diabetes appear.

In contrast to earlier assumptions, researchers have found that, at diagnosis, majorities of people with Type I diabetes have circulating C-peptide, a marker of insulin production by the pancreas. While C-peptide levels are reduced in comparison to people without the disease, the measurable and inducible C-peptide is very suggestive of functional beta cell mass. This observation is important for future therapies as the positive benefit of immune modulation in the NOD mouse is best realized when a pancreatic beta cell mass capable of promoting euglycemia is present. Moreover, in humans the presence of C-peptide has been associated with improved control of diabetes and less risk of life- threatening hypoglycemia. Thus, preservation of C-peptide, as well as expansion of beta cell mass in new-onset type I diabetes, is a major focus of therapeutic investigation.

Type II Diabetes:

Type II Diabetes affects about 26 million in the United States. In Type II Diabetes, the beta cells still produce insulin. However, either the cells do not respond properly to the insulin or the insulin produced naturally is not enough to meet the needs of the body. Insulin is usually still present in a person with Type II Diabetes, but it does not work as well as it should. Measurable indications of diabetes are as follows:

Fasting Plasma Glucose(FPG) - >99 (mg/dl)

Glucose tolerance (OGTT) 2 hours after meal - > 139 (mg/dl)

A1c > 5.7 %

The following characteristics are common to Type II and Pre-Diabetes:

Usually overweight, particularly abdominal area.

Few to no symptoms

Blurred vision

Cuts that are slow to heal

Tingling or numbness in feet and hands

Recurring mouth, skin and bladder infections

Increased urination, thirst and appetite

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What is Diabetes?

Diabetes Overview

Type I Diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection—the immune system—turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

At present, scientists do not know exactly what causes the body’s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults but can appear at any age.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

Type II Diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents, especially among African American, Mexican American, and Pacific Islander youth.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.

Gestational Diabetes

Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.

About 3 to 8 percent of pregnant women in the United States develop gestational diabetes. As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms.

Diabetes in Youth

The SEARCH for Diabetes in Youth multicenter study, funded by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), has determined that

based on data from 2002 to 2003, a total of 15,000 youth in the United States were newly diagnosed with type 1 diabetes each year. In addition, about 3,700 youth were newly diagnosed with type 2 diabetes each year.

non-Hispanic white youth had the highest rate of new cases of type 1 diabetes.

type 2 diabetes was rarely diagnosed among youth younger than 10 years of age.

Additional information about specific rates of new cases of type 1 and type 2 diabetes among youth younger than age 20 can be found in the fact sheet National Diabetes Statistics, 2007, available online at www.diabetes.niddk.nih.gov/dm/pubs/statistics.

Other Types of Diabetes

A number of other types of diabetes exist. A person may exhibit characteristics of more than one type. For example, in latent autoimmune diabetes in adults (LADA), also called type 1.5 diabetes or double diabetes, people show signs of both type 1 and type 2 diabetes.

Other types of diabetes include those caused by

genetic defects of the beta cell—the part of the pancreas that makes insulin—such as maturity-onset diabetes of the young (MODY) or neonatal diabetes mellitus (NDM)

genetic defects in insulin action, resulting in the body’s inability to control blood glucose levels, as seen in leprechaunism and the Rabson-Mendenhall syndrome

diseases of the pancreas or conditions that damage the pancreas, such as pancreatitis and cystic fibrosis

excess amounts of certain hormones resulting from some medical conditions—such as cortisol in Cushing’s syndrome—that work against the action of insulin

medications that reduce insulin action, such as glucocorticoids, or chemicals that destroy beta cells

infections, such as congenital rubella and cytomegalovirus

rare immune-mediated disorders, such as stiff-man syndrome, an autoimmune disease of the central nervous system

genetic syndromes associated with diabetes, such as Down syndrome and Prader-Willi syndrome

Latent Autoimmune Diabetes in Adults (LADA)

People who have LADA show signs of both type 1 and type 2 diabetes. Diagnosis usually occurs after age 30. Researchers estimate that as many as 10 percent of people diagnosed with type 2 diabetes have LADA. Some experts believe that LADA is a slowly developing kind of type 1 diabetes because patients have antibodies against the insulin-producing beta cells of the pancreas.

Most people with LADA still produce their own insulin when first diagnosed, like those with type 2 diabetes. In the early stages of the disease, people with LADA do not require insulin injections. Instead, they control their blood glucose levels with meal planning, physical activity, and oral diabetes medications. However, several years after diagnosis, people with LADA must take insulin to control blood glucose levels. As LADA progresses, the beta cells of the pancreas may no longer make insulin because the body’s immune system has attacked and destroyed them, as in type 1 diabetes.

Diabetes Caused by Genetic Defects of the Beta Cell

Genetic defects of the beta cell cause several forms of diabetes. For example, monogenic forms of diabetes result from mutations, or changes, in a single gene. In most cases of monogenic diabetes, the gene mutation is inherited. In the remaining cases, the gene mutation develops spontaneously. Most mutations in monogenic diabetes reduce the body’s ability to produce insulin. Genetic testing can diagnose most forms of monogenic diabetes.

NDM and MODY are the two main forms of monogenic diabetes. NDM is a form of diabetes that occurs in the first 6 months of life. Infants with NDM do not produce enough insulin, leading to an increase in blood glucose. NDM can be mistaken for the much more common type 1 diabetes, but type 1 diabetes usually occurs after the first 6 months of life. More information about the two types of NDM, permanent neonatal diabetes and transient neonatal diabetes mellitus, is provided in the fact sheet Monogenic Forms of Diabetes, available online from the NDIC at www.diabetes.nidd.nih.gov/dm/pubs/mody. For printed copies of the fact sheet, call the NDIC at 1–800–860–8747.

MODY usually first occurs during adolescence or early adulthood. However, MODY sometimes remains undiagnosed until later in life. A number of different gene mutations have been shown to cause MODY, all of which limit the pancreas’ ability to produce insulin. This process leads to the high blood glucose levels characteristic of diabetes. More information about specific types of MODY is provided in the fact sheet Monogenic Forms of Diabetes.

Diabetes Caused by Genetic Defects in Insulin Action

A number of types of diabetes result from genetic defects in insulin action. Changes to the insulin receptor may cause mild hyperglycemia—high blood glucose—or severe diabetes. Symptoms may include acanthosis nigricans, a skin condition characterized by darkened skin patches, and, in women, enlarged and cystic ovaries plus virilization and the development of masculine characteristics such as excess facial hair. Two syndromes in children, leprechaunism and the Rabson-Mendenhall syndrome, cause extreme insulin resistance.

Diabetes Caused by Diseases of the Pancreas

Injuries to the pancreas from trauma or disease can cause diabetes. This category includes pancreatitis, infection, and cancer of the pancreas. Cystic fibrosis and hemochromatosis can also damage the pancreas enough to cause diabetes.

Diabetes Caused by Endocrinopathies

Excess amounts of certain hormones that work against the action of insulin can cause diabetes. These hormones and their related conditions include growth hormone in acromegaly, cortisol in Cushing’s syndrome, glucagon in glucagonoma, and epinephrine in pheochromocytoma.

Diabetes Caused by Medications or Chemicals

A number of medications and chemicals can interfere with insulin secretion, leading to diabetes in people with insulin resistance. These medications and chemicals include pentamidine, nicotinic acid, glucocorticoids, thyroid hormone, phenytoin (Dilantin), and Vacor, a rat poison.

Diabetes Caused by Infections

Several infections are associated with the occurrence of diabetes, including congenital rubella, coxsackievirus B, cytomegalovirus, adenovirus, and mumps.

Rare Immune-mediated Types of Diabetes

Some immune-mediated disorders are associated with diabetes. About one-third of people with stiff-man syndrome develop diabetes. In other autoimmune diseases, such as systemic lupus erythematosus, patients may have anti-insulin receptor antibodies that cause diabetes by interfering with the binding of insulin to body tissues.

Other Genetic Syndromes Sometimes Associated with Diabetes

Many genetic syndromes are associated with diabetes. These conditions include Down syndrome, Klinefelter’s syndrome, Huntington’s chorea, porphyria, Prader-Willi syndrome, and diabetes insipidus.

How is diabetes diagnosed?

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. The test is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

A blood glucose level of 100 milli grams per deciliter (mg/dL) or higher after an 8-hour fast. This test is called the fasting blood glucose test.

A blood glucose level of 140 mg/dL or higher 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).

A random—taken at any time of day—blood glucose level of 140 mg/dL or higher, along with the presence of diabetes symptoms.

Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 140 mg/dL, or a 3-hour level of 140 mg/dL.

What is pre-diabetes?

People with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.

Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some people have both IFG and IGT.

IFG is a condition in which the blood glucose level is high—100 mg/dL—after an overnight fast, but is not high enough to be classified as diabetes. The former definition of IFG was 100 mg/dL.

IGT is a condition in which the blood glucose level is high—140 mg/dL—after a 2-hour OGTT, but is not high enough to be classified as diabetes.

Pre-diabetes is becoming more common in the United States. The U.S. Department of Health and Human Services estimates that at least 65 million U.S. adults ages 20 or older had pre-diabetes in 2007. Those with pre-diabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay diabetes.

The good news is that people with pre-diabetes can do a lot to prevent or delay diabetes. Studies have clearly shown that people can lower their risk of developing diabetes by losing 5 to 7 percent of their body weight through diet and increased physical activity. A major study of more than 3,000 people with IGT found that diet and exercise resulting in a 5 to 7 percent weight loss—about 10 to 14 pounds in a person who weighs 200 pounds—lowered the incidence of type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising—most chose walking—at least 30 minutes a day, 5 days a week.

What are the scope and impact of diabetes?

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2006, it was the seventh leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. In 2004, among people ages 65 years or older, heart disease was noted on 68 percent of diabetes-related death certificates; stroke was noted on 16 percent of diabetes-related death certificates for the same age group.

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

In 2007, diabetes cost the United States $174 billion. Indirect costs, including disability payments, time lost from work, and reduced productivity, totaled $58 billion. Direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $116 billion.

Who gets diabetes?

Diabetes is not contagious. People cannot “catch” it from each other. However, certain factors can increase the risk of developing diabetes.

Type 1 diabetes occurs equally among males and females but is more common in whites than in nonwhites. Data from the World Health Organization’s Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown. Type 1 diabetes develops most often in children but can occur at any age.

Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanics/Latinos. National survey data in 2007 indicate a range in the prevalence of diagnosed and undiagnosed diabetes in various populations ages 20 years or older:

Age 20 years or older: 23.5 million, or 10.7 percent, of all people in this age group have diabetes.

Age 60 years or older: 12.2 million, or 23.1 percent, of all people in this age group have diabetes.

Men: 12.0 million, or 11.2 percent, of all men ages 20 years or older have diabetes.

Women: 11.5 million, or 10.2 percent, of all women ages 20 years or older have diabetes.

Non-Hispanic whites: 14.9 million, or 9.8 percent, of all non-Hispanic whites ages 20 years or older have diabetes.

Non-Hispanic blacks: 3.7 million, or 14.7 percent, of all non-Hispanic blacks ages 20 years or older have diabetes.

Diabetes prevalence in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanics/Latinos and other minority groups at increased risk make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates from the CDC, diabetes will affect one in three people born in 2000 in the United States. The CDC also projects that the prevalence of diagnosed diabetes in the United States will increase 165 percent by 2050.

How is diabetes managed?

Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Doctors may also prescribe another type of injectable medicine. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require one or more diabetes medicines—pills, insulin, and other injectable medicine—to control their blood glucose levels.

Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control—it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and the use of medications, if needed. By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by a person’s health care team, and smoking cessation can also help lower risk.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low—a condition known as hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.

A person can also become ill if blood glucose levels rise too high.
People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians—internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include

a primary care provider such as an internist, a family practice doctor, or a pediatrician

an endocrinologist—a specialist in diabetes care

a dietitian, a nurse, and other health care providers who are certified diabetes educators—experts in providing information about managing diabetes

a podiatrist—for foot care

an ophthalmologist or an optometrist—for eye care

The team can also include other health care providers, such as cardiologists and other specialists. The team for a pregnant woman with type 1, type 2, or gestational diabetes should include an obstetrician who specializes in caring for women with diabetes. The team can also include a pediatrician or a neonatologist with experience taking care of babies born to women with diabetes.

The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.

This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches—intensive management and standard management—on the development and progression of eye, kidney, nerve, and cardiovascular complications of diabetes. Intensive treatment aimed to keep A1C levels as close to normal—6 percent—as possible. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a follow-up study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted more than 10 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

What will the future bring?

IIs here with Hope Diabetes Center Ambulatory Reversal Program -ARP.

Points to Remember

What is diabetes?

a disorder of metabolism—the way the body uses or converts food for energy and growth

Pre-Diabetes affects about 79 million in the United States. In Pre-Diabetes, the beta cells still produce insulin. However, either the cells do not respond properly to the insulin or the insulin produced naturally is not enough to meet the needs of the body. Insulin is usually still present in a person with Pre-Diabetes, but it does not work as well as it should. Measurable indications of diabetes are as follows:

Fasting Plasma Glucose(FPG) - >99 (mg/dl)

Glucose tolerance (OGTT) 2 hours after meal - > 139 (mg/dl)

A1c > 5.7 %

The following characteristics are common to Type II and Pre-Diabetes:

Usually overweight, particularly abdominal area.

Few to no symptoms

Blurred vision

Cuts that are slow to heal

Tingling or numbness in feet and hands

Recurring mouth, skin and bladder infections

Increased urination, thirst and appetite

Pre-Diabetes is a relatively new term that came into wider use beginning in 2002, after publication of results from the Diabetes Prevention Program intervention trial. Physicians and other health-care providers have used various other terms to describe Pre-Diabetes. The use of different terms might have produced confusion among persons over what their health-care providers diagnosed. Hence, screening recommendations for prediabetes are essentially the same as those for diabetes. <History of Pre-Diabetes>

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Insulin Resistance / Pre-Diabetes

What is insulin resistance?

Insulin resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. Glucose is a form of sugar that is the body’s main source of energy.

The body’s digestive system breaks food down into glucose, which then travels in the bloodstream to cells throughout the body. Glucose in the blood is called blood glucose, also known as blood sugar. As the blood glucose level rises after a meal, the pancreas releases insulin to help cells take in and use the glucose.

When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, the pancreas fails to keep up with the body’s need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time.

Insulin resistance increases the chance of developing type 2 diabetes and heart disease. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems.

What causes insulin resistance?

Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance.

Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having excess weight around the waist, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood. Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.

Metabolic Syndrome

Metabolic syndrome is defined as the presence of any three of the following conditions:

waist measurement of 40 inches or more for men and 35 inches or more for women

Similar definitions have been developed by the World Health Organization and the American Association of Clinical Endocrinologists.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007.

People with pre-diabetes are at increased risk of developing type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes. Type 2 diabetes is sometimes defined as the form of diabetes that develops when the body does not respond properly to insulin, as opposed to type 1 diabetes, in which the pancreas makes little or no insulin.

Studies have shown that most people with pre-diabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight—about 10 to 15 pounds for someone who weighs 200 pounds—by making changes in their diet and level of physical activity. People with pre-diabetes also are at increased risk of developing cardiovascular disease.

What are the symptoms of insulin resistance and pre-diabetes?

Insulin resistance and pre-diabetes usually have no symptoms. People may have one or both conditions for several years without noticing anything. People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Other possible sites for dark patches include elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans.

How are insulin resistance and pre-diabetes diagnosed?

Health care providers use blood tests to determine whether a person has pre-diabetes but do not usually test for insulin resistance. Insulin resistance can be assessed by measuring the level of insulin in the blood. However, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most doctors’ offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. If tests indicate pre-diabetes or metabolic syndrome, insulin resistance most likely is present.

Diabetes and pre-diabetes can be detected with one of the following tests:

Fasting glucose test. This test measures blood glucose in people who have not eaten anything for at least 8 hours. This test is most reliable when done in the morning. Fasting glucose levels of 100 to 125 mg/dL are above normal but not high enough to be called diabetes. This condition is called pre-diabetes or IFG. People with IFG often have had insulin resistance for some time. They are much more likely to develop diabetes than people with normal blood glucose levels.

Glucose tolerance test. This test measures blood glucose after people fast for at least 8 hours and 2 hours after they drink a sweet liquid provided by a doctor or laboratory. A blood glucose level between 140 and 199 mg/dL means glucose tolerance is not normal but is not high enough for a diagnosis of diabetes. This form of pre-diabetes is called IGT and, like IFG, it points toward a history of insulin resistance and a risk for developing diabetes.

People whose test results indicate they have pre-diabetes should have their blood glucose levels checked again in 1 to 2 years.

Risk Factors for Pre-diabetes and Type 2 Diabetes

The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45.
Risk factors for pre-diabetes and diabetes—in addition to being overweight or obese or being age 45 or older—include the following:

being physically inactive

having a parent or sibling with diabetes

having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander

giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes—diabetes first found during pregnancy

having high blood pressure—140/90 or above—or being treated for high blood pressure

having other conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans

having a history of cardiovascular disease

If test results are normal, testing should be repeated at least every year. Health care providers may recommend more frequent testing depending on initial results and risk status.

Can insulin resistance and pre-diabetes be reversed?

Yes. Physical activity and weight loss help the body respond better to insulin. By losing weight and being more physically active, people with insulin resistance or pre-diabetes may avoid developing type 2 diabetes.

The Diabetes Prevention Program (DPP) and other large studies have shown that people with pre-diabetes can often prevent or delay diabetes if they lose a modest amount of weight by cutting fat and calorie intake and increasing physical activity—for example, walking 30 minutes a day 5 days a week. Losing just 5 to 7 percent of body weight prevents or delays diabetes by nearly 60 percent. In the DPP, people aged 60 or older who made lifestyle changes lowered their chances of developing diabetes by 70 percent. Many participants in the lifestyle intervention group returned to normal blood glucose levels and lowered their risk for developing heart disease and other problems associated with diabetes. The DPP also showed that the diabetes drug metformin reduced the risk of developing diabetes by 31 percent.

People with insulin resistance or pre-diabetes can help their body use insulin normally by being physically active, making wise food choices, and reaching and maintaining a healthy weight. Physical activity helps muscle cells use blood glucose for energy by making the cells more sensitive to insulin.

Body Mass Index (BMI)

BMI is a measurement of body weight relative to height. Adults aged 20 or older can use the BMI table below to find out whether they are normal weight, overweight, obese, or extremely obese. To use the table, follow these steps:

Find the person’s height in the left-hand column.

Move across the row to the number closest to that person’s weight.

Check the number at the top of that column.

The number at the top of the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, obese, or extremely obese. People who are overweight, obese, or extremely obese should consider talking with a doctor about ways to lose weight to reduce the risk of diabetes.

The BMI table has certain limitations. It may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. BMI for children and teens must be determined based on age and sex in addition to height and weight. Information about BMI in children and teens, including a BMI calculator, is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults.

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.

Causes of insulin resistance and pre-diabetes include genetic factors, excess weight, and lack of physical activity.

Being physically active, making wise food choices, and reaching and maintaining a healthy weight can help prevent or reverse insulin resistance and pre-diabetes.

The Diabetes Prevention Program (DPP) study confirmed that people at risk for developing type 2 diabetes can prevent or delay the onset of diabetes by losing 5 to 7 percent of their body weight through regular physical activity and a diet low in fat and calories.

It is essential that diabetics are aware of the complications that can occur as a result of being diabetic, to ensure that the first symptoms of any possible illness are spotted before they develop. Diabetes complications involve the disruption of a variety of bodily systems.

Diabetes complications may occur over many different timescales, from the date of diagnosis, or many years after diabetes has developed. Diabetes complications is broken down by areas of the body and organs. This is complemented with guides to complications and screening and prevention.

Heart Disease and StrokePeople with diabetes have extra reason to be mindful of heart and blood vessel disease. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation:

Symptoms

Irregular heartbeats

Dizzy spells

Chest pains

Slow healing of cuts and sores

Numbness or weakness in an arm or leg

Leg cramps

Swollen ankles

Shortness of breath

Note:These symptoms may also be caused by some medical condition besides blood vessel damage.

Things you need to know

Smoking and blood fat level can cause blood vessels to narrow, which makes it difficult for the blood to flow throughout the body. Both can increase the chance of a heart attack. Diabetes can also damage the blood vessels that supply blood to all parts of the body, increasing the risk of heart attack.

What can you do? Test your blood every 3 to 4 months.

Total Cholesterol

LDL (bad) Cholesterol

HDL (good) Cholesterol

Triglycerides

EKG

Blood Pressure (Every Week)

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How to test your blood Pressure..

What is a stroke?

A stroke is sometimes called a "brain attack." A stroke can injure the brain like a heart attack can injure the heart. A stroke occurs when part of the brain doesn't get the blood it needs.
There are two types of stroke:

Ischemic stroke (most common type) -- This type of stroke happens when blood is blocked from getting to the brain. This often happens because the artery is clogged with fatty deposits (atherosclerosis) or a blood clot.

Hemorrhagic stroke -- This type of stroke happens when a blood vessel in the brain bursts, and blood bleeds into the brain. This type of stroke can be caused by an aneurysm -- a thin or weak spot in an artery that balloons out and can burst.

Both types of stroke can cause brain cells to die. This may cause a person to lose control of their speech, movement, and memory. If you think you are having a stroke, call 911.

What is a “mini-stroke”?

A “mini-stroke”, also called a transient ischemic attack or (TIA), happens when, for a short time, less blood than normal gets to the brain. You may have some signs of stroke or you may not notice any signs. A “mini-stroke” lasts from a few minutes up to a day. Many people do not even know they have had a stroke. A “mini-stroke” can be a sign of a full stroke to come. If you think you are having a “mini-stroke”, call 911.

What are the signs of a stroke?

A stroke happens fast. Most people have two or more signs.
The most common signs are:

Sudden numbness or weakness of face, arm, or leg (mainly on one side of the body)

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, or loss of balance

Sudden confusion or trouble talking or understanding speech

Sudden bad headache with no known cause

Women may have unique symptoms:

Sudden face and arm or leg pain

Sudden hiccups

Sudden nausea (feeling sick to your stomach)

Sudden tiredness

Sudden chest pain

Sudden shortness of breath (feeling like you can’t get enough air)

Sudden pounding or racing heartbeat

If you have any of these symptoms,call 911.

How is stroke diagnosed?

The doctor will usually start by asking the patient what happened and when the symptoms began. Then the doctor will ask the patient some questions to see if she or he is thinking clearly. The doctor also will test the patient's reflexes to see if she or he may have had any physical damage. This helps the doctor find out which tests are needed.
The doctor may order one or more of the following tests:

Imaging tests that give a picture of the brain. These include CT (computed tomography) scanning, sometimes called CAT scans and MRI (magnetic resonance imaging) scanning. CT scans are useful for finding out if a stroke is caused by a blockage or by bleeding in the brain.

Electrical tests, such as EEG (electroencephalogram) and an evoked response test to record the electrical impulses and sensory processes of the brain.

Blood flow tests, such as Doppler ultrasound tests, to show any changes in the blood flow to the brain.

What are the effects of stroke?

It depends on the type of stroke, the area of the brain where the stroke occurs, and the extent of brain injury. A mild stroke can cause little or no brain damage. A major stroke can cause severe brain damage and even death.
A stroke can occur in different parts of the brain. The brain is divided into four main parts: the right hemisphere (or half), the left hemisphere (or half), the cerebellum, and the brain stem.

A stroke in the right half of the brain can cause:

Problems judging distances — The stroke survivor may misjudge distances and fall or be unable to guide her hands to pick something up.

Impaired judgment and behavior — The stroke survivor may try to do things that she should not do, such as driving a car.

Short-term memory loss — The stroke survivor may be able to remember events from 30 years ago, but not what she ate for breakfast that morning.

A stroke in the left half of the brain can cause:

Speech and language problems — The stroke survivor may have trouble speaking or understanding others.

Slow and cautious behavior — The stroke survivor may need a lot of help to complete tasks.

Memory problems — The stroke survivor may not remember what she did ten minutes ago or she may have a hard time learning new things.

A stroke in the cerebellum, or the part of the brain that controls balance and coordination, can cause:

Abnormal reflexes of the head and upper body

Balance problems

Dizziness, nausea (feeling sick to your stomach), and vomiting

Strokes in the brain stem are very harmful because the brain stem controls all our body's functions that we don't have to think about, such as eye movements, breathing, hearing, speech, and swallowing. Since impulses that start in the brain must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis, or not be able to move or feel on one or both sides of the body.
In many cases, a stroke weakens the muscles, making it hard to walk, eat, or dress without help. Some symptoms may improve with time and rehabilitation or therapy.

Who is at risk for stroke?

It is a myth that stroke occurs only in older adults. A person of any age can have a stroke. But, stroke risk does increase with age. For every 10 years after the age of 55, the risk of stroke doubles, and two-thirds of all strokes occur in people over 65 years old. Stroke also seems to run in some families. Stroke risk doubles for a woman if someone in her immediate family (mom, dad, sister, or brother) has had a stroke.
Compared to white women, African American women have more strokes and have a higher risk of disability and death from stroke. This is partly because more African American women have high blood pressure, a major stroke risk factor. Women who smoke or who have high blood pressure, atrial fibrillation (a kind of irregular heart beat), heart disease, or diabetes are more likely to have a stroke. Hormonal changes with pregnancy, childbirth, and menopause are also linked to an increased risk of stroke.

How do I prevent a stroke?

Experts think that up to 80% of strokes can be prevented. Some stroke risk factors cannot be controlled, such as age, family history, and ethnicity. But you can reduce your chances of having a stroke by taking these steps:

Know your blood pressure. Your heart moves blood through your body. If it is hard for your heart to do this, your heart works harder, and your blood pressure will rise. People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years. If you have high blood pressure, your doctor may suggest you make some lifestyle changes, such as eating less salt (DASH Eating Plan) and exercising more. Your doctor may also prescribe medicine to help lower your blood pressure.

Don't smoke. If you smoke, try to quit. If you are having trouble quitting, there are products and programs that can help:

Nicotine patches and gums

Support groups

Programs to help you stop smoking

Ask your doctor or nurse for help. For more information on quitting, visit Quitting Smoking.

Get tested for diabetes. People with diabetes have high blood glucose (often called blood sugar). People with high blood sugar often have no symptoms, so have your blood sugar checked regularly. Having diabetes raises your chances of having a stroke. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.

Get your cholesterol and triglyceride levels tested. Cholesterol is a waxy substance found in all parts of your body. When there is too much cholesterol in your blood, cholesterol can build up on the walls of your arteries. Cholesterol can clog your arteries and keep your brain from getting the blood it needs. This can cause a stroke. Triglycerides are a form of fat in your blood stream. High levels of triglycerides are linked to stroke in some people. People with high blood cholesterol or high blood triglycerides often have no symptoms, so have your blood cholesterol and triglyceride levels checked regularly. If your cholesterol or triglyceride levels are high, talk to your doctor about what you can do to lower them. You may be able to lower your cholesterol and triglyceride levels by eating better and exercising more. Your doctor may prescribe medication to help lower your cholesterol.

Maintain a healthy weight. Being overweight raises your risk for stroke. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. Make healthy food choices and get plenty of exercise. Each week, aim for at least 2 hours and 30 minutes of moderate-intensity aerobic physical activity, 1 hour and 15 minutes of vigorous-intensity aerobic physical activity, or a combination of moderate and vigorous activity. Start by adding more fruits, vegetables, and whole grains to your diet. Take a brisk walk on your lunch break or take the stairs instead of the elevator.

If you drink alcohol, limit it to no more than one drink (one 12 ounce beer, one 5 ounce glass of wine, or one 1.5 ounce shot of hard liquor) a day.

Find healthy ways to cope with stress. Lower your stress level by talking to your friends, exercising, or writing in a journal.

Should I take a daily aspirin to prevent stroke?

Aspirin may be helpful for women at high risk, such as women who have already had a stroke. Aspirin can have serious side effects and may be harmful when mixed with certain medications. If you're thinking about taking aspirin, talk to your doctor first. If your doctor thinks aspirin is a good choice for you, be sure to take it exactly as your doctor tells you to.

Does taking birth control pills increase my risk for stroke?

Taking birth control pills is generally safe for young, healthy women. But birth control pills can raise the risk of stroke for some women, especially women over 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke. Talk with your doctor if you have questions about the pill.If you are taking birth control pills, and you have any of the symptoms listed below, call 911:

Eye problems such as blurred or double vision

Pain in the upper body or arm

Bad headaches

Problems breathing

Spitting up blood

Swelling or pain in the leg

Yellowing of the skin or eyes

Breast lumps

Unusual (not normal) heavy bleeding from your vagina

Does using the birth control patch increase my risk for stroke?

The patch is generally safe for young, healthy women. The patch can raise the risk of stroke for some women, especially women over 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke.
Recent studies show that women who use the patch may be exposed to more estrogen (the female hormone in birth control pills and the patch that keeps users from becoming pregnant) than women who use the birth control pill. Research is underway to see if the risk for blood clots (which can lead to heart attack or stroke) is higher in patch users. Talk with your doctor if you have questions about the patch.If you are using the birth control patch, and you have any of the symptoms listed below, call 911:

Eye problems such as blurred or double vision

Pain in the upper body or arm

Bad headaches

Problems breathing

Spitting up blood

Swelling or pain in the leg

Yellowing of the skin or eyes

Breast lumps

Unusual (not normal) heavy bleeding from your vagina

How is stroke treated?

Strokes caused by blood clots can be treated with clot-busting drugs such as TPA, or tissue plasminogen activator. TPA must be given within three hours of the start of a stroke to work, and tests must be done first. This is why it is so important for a person having a stroke to get to a hospital fast.
Other medicines are used to treat and to prevent stroke. Anticoagulants, such as warfarin, and antiplatelet agents, such as aspirin, block the blood's ability to clot and can help prevent a stroke in patients with high risk, such as a person who has atrial fibrillation (a kind of irregular heartbeat).
Surgery is sometimes used to treat or prevent stroke. Carotid endarterectomy is a surgery to remove fatty deposits clogging the carotid artery in the neck, which could lead to a stroke. For hemorrhagic stroke, a doctor may perform surgery to place a metal clip at the base of an aneurysm (a thin or weak spot in an artery that balloons out and can burst) or remove abnormal blood vessels.

What about rehabilitation?

Rehabilitation is a very important part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn, or redefine how you live. Stroke rehabilitation is designed to help you return to independent living.
Rehabilitation does not reverse the effects of a stroke. Its goals are to build your strength, capability, and confidence so you can continue your daily activities despite the effects of your stroke. Rehabilitation services may include:

Physical therapy to restore movement, balance, and coordination

Occupational therapy to relearn basic skills such as bathing and dressing

Speech therapy to relearn how to talk

Kidney DiseaseDiabetes can damage the kidneys, which not only can cause them to fail, but can also ability to filter out waste products.

Complications

Dialysis and Transplantation

Symptoms

There are none. Kidney disease can be detected through a regular visit to your doctor and testing your blood and urine.

High Blood Pressure

Things you need to know

Diabetics are 19 times more likely than those without diabetes to develop problems with the kidney.

Chronic Kidney Disease is called Nephropathy

To prevent keep your blood sugar levels close to normal range.

Before meal < 100 (mg/dL)

2 hours after meal < 140 (mg/dL)

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Keep your kidney healthy

What are diabetes problems?

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

Your kidneys are two bean-shaped organs about the size of your fist. They are located just below the rib cage, near your back.
This information is about kidney problems caused by diabetes. You will learn the things you can do each Kidneys day and during each year to stay healthy and prevent diabetes problems.

What should I do each day to stay healthy with diabetes?

Follow the healthy eating plan that you and your doctor or dietitian have worked out.

Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.

Take your medicines as directed.

Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.

What do my kidneys do?

The kidneys act as filters to clean the blood. They get rid of wastes and send along filtered fluid. The tiny filters in the kidneys are called glomeruli.
You have two kidneys. Your kidneys clean your blood and make urine. This drawing shows a cross section of a kidney.
When kidneys are healthy, the artery brings blood and wastes from the bloodstream into the kidneys. The glomeruli clean the blood. Then wastes and extra fluid go out into the urine through the ureter. Clean blood leaves the kidneys and goes back into the bloodstream through the vein.

How can I prevent diabetes kidney problems?

Keep your blood glucose as close to normal as you can. Ask your doctor what blood glucose numbers are healthy for you.

Keep your blood pressure below 130/80 to help prevent kidney damage. Blood pressure is written with two numbers separated by a slash. For example, 120/70 is said as “120 over 70.”

Ask your doctor what numbers are best for you. If you take blood pressure pills every day, take them as your doctor tells you. Keeping your blood pressure under control will also slow down or prevent damage to your eyes, heart, and blood vessels.

Keep your blood pressure below 130/80.

Ask your doctor if you should take pills to slow down kidney damage. Two kinds are available:

ACE (angiotensin converting enzyme) inhibitor

ARB (angiotensin receptor blocker)

Follow the healthy eating plan you work out with your doctor or dietitian. If you already have kidney problems, your dietitian may suggest you cut back on protein, such as meat.

Have your kidneys checked at least once a year by having your urine tested for small amounts of protein. This test is called the microalbumin test.

Have your blood tested at least once a year for creatinine. The result of this test should be used to estimate your glomerular filtration rate (GFR), a measure of kidney function.

Pills can help you control your blood pressure and slow down kidney damage.

Have any other kidney tests your doctor thinks you need.

Avoid taking painkillers regularly. Daily use of pills like aspirin or acetaminophen can damage the kidneys. Taking a single dose of aspirin every day to protect the heart, however, should be safe. Taking acetaminophen for occasional pain should also be safe. But if you are dealing with chronic pain, such as arthritis, work with your doctor to find a way to control your pain without putting your kidneys at risk.

See a doctor right away for bladder or kidney infections. You may have an infection if you have these symptoms:

pain or burning when you urinate

a frequent urge to go to the bathroom

urine that looks cloudy or reddish

fever or a shaky feeling

pain in your back or on your side below the ribs

How can my doctor protect my kidneys during special x-ray tests?

X-ray tests using a contrast agent pose a risk to your kidneys. If you need x rays, your doctor can give you extra water before and after the x rays to protect your kidneys. Or your doctor may decide to order a test that does not use a contrast agent.

How can diabetes hurt my kidneys?

When the kidneys are working well, the tiny filters in your kidneys, the glomeruli, keep protein inside your body. You need the protein to stay healthy.

High blood glucose and high blood pressure damage the kidneys’ filters. When the kidneys are damaged, the protein leaks out of the kidneys into the urine. Damaged kidneys do not do a good job of cleaning out wastes and extra fluid. Wastes and fluid build up in your blood instead of leaving the body in urine.

No protein is leaking from the healthy kidney. Protein is leaking from the unhealthy kidney.

Kidney damage begins long before you notice any symptoms. An early sign of kidney damage is when your kidneys leak small amounts of a protein called albumin into the urine. But the only way to know about this leakage is to have your urine tested.

With more damage, the kidneys leak more and more protein. This problem is called proteinuria. More and more wastes build up in the blood. This damage gets worse until the kidneys fail.
Diabetic nephropathy is the medical term for kidney problems caused by diabetes. Nephropathy affects both kidneys at the same time.

What can I do if I have kidney problems caused by diabetes?

Once you have kidney damage, you cannot undo it. But you can slow it down or stop it from getting worse by controlling your blood pressure, taking your ACE inhibitors or ARBs, and having your kidney function tested regularly. However, if you are pregnant, you should not take ACE inhibitors or ARBs.
Keeping blood pressure under control helps to keep your kidneys healthy.

How will I know if my kidneys fail?

At first, you cannot tell. Kidney damage from diabetes happens so slowly that you may not feel sick at all for many years. You will not feel sick even when your kidneys do only half the job of normal kidneys. You may not feel any signs of kidney failure until your kidneys have almost stopped working. However, getting your urine and blood checked every year can tell you how well your kidneys are working.

Once your kidneys fail, you may feel sick to your stomach and tired all the time. Your hands and feet may swell from extra fluid in your body.
You may feel sick to your stomach when your kidneys stop working.

What happens if my kidneys fail?

One way to treat kidney failure is with dialysis. Dialysis is a treatment that does some of the work your kidneys used to do. Two types of dialysis are available. You and your doctor will decide what type will work best for you.
Dialysis is a treatment that takes waste products and extra fluid out of your body.

Hemodialysis. In hemodialysis, your blood flows through a tube from your arm to a machine that filters out the waste products and extra fluid. The clean blood flows back to your arm.

Peritoneal dialysis. In peritoneal dialysis, your belly is filled with a special fluid. The fluid collects waste products and extra water from your blood. Then the fluid is drained from your belly and thrown away.

Another way to treat kidney failure is to have a kidney transplant. This operation gives you a new kidney. The kidney can be from a close family member, friend, or someone you do not know. You may be on dialysis for a long time. Many people are waiting for a new kidney. A new kidney must be a good match for your body.

Will I know if I start to have kidney problems?

No. You will know you have kidney problems only if your doctor checks your blood for creatinine and your urine for protein. Do not wait for signs of kidney damage to have your blood and urine checked.

How can I find out if I have kidney problems?

Two lab tests can tell you and your doctor how well your kidneys are working.

Each year, make sure your doctor checks a sample of your urine to see if your kidneys are leaking small amounts of protein called microalbumin.

At least once each year, your doctor should check your blood to measure the amount of creatinine. Creatinine is a waste product your body makes. If your kidneys are not cleaning waste products from your blood, they can build up and make you sick. Your doctor can use your creatinine level to check your GFR. GFR stands for glomerular filtration rate. Results of this test tell you how well your kidneys are removing wastes from the blood.

Neuropathy / Foot ComplicationsThe most common complications of diabetes is diabetic neuropathy. Neuropathy means damage to the nerve cells that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs.

Complications

Due to loss of feeling in your feet, you may not notice cuts and infections.

People with diabetes are far more likely (65%) to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.

Ulcers - Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

Symptoms

Tingle, burn, ache, or throb on your feet and lower legs.

Numbness in feet, hands and lower legs.

Diarrhea that will not stop.

Impotence in men.

Less able to have an orgasm or climax.

Abdominal pain.

Feet that feel cold to the touch.

Lack of hair on your feet.

Things you need to know

Check your feet daily for any changes, such as blisters, cuts, ulcers, redness and large calluses.

Always check your shoes for any rough edges, sand and any object that may cause irritation.

Dry your feet with a soft towel after bathing. Wetness between your toes allow fungus to grow, which can lead to serious infection.

Inspect your feet with a mirror daily. If your feet are dry and cracked use a moisturizer cream (avoid cream between your toes).

Keep your feet and skin healthy

What are diabetes problems?

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

This information is about feet and skin problems caused by diabetes. You will learn the things you can do each day and during each year to stay healthy and prevent diabetes problems.

High blood glucose can cause feet and skin problems.

How can diabetes hurt my feet?

High blood glucose from diabetes causes two problems that can hurt your feet:

Nerve damage. One problem is damage to nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can lead to a sore or an infection.

Poor blood flow. The second problem happens when not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheralvascular disease, also called PVD. Smoking when you have diabetes makes blood flow problems much worse.

These two problems can work together to cause a foot problem.
Make sure you wear shoes that fit well.

For example, you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor blood flow to your legs and feet can slow down healing. Once in a while a bad infection never heals. The infection might cause gangrene. If a person has gangrene, the skin and tissue around the sore die. The area becomes black and smelly.

To keep gangrene from spreading, a doctor may have to do surgery to cut off a toe, foot, or part of a leg. Cutting off a body part is called an amputation.

What can I do to take care of my feet?

Look at your feet every day to check for problems.

Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.

Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.

If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.

File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.

Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.

Always wear slippers or shoes to protect your feet from injuries.

Always wear slippers or shoes to protect your feet.

Always wear socks or stockings to avoid blisters. Do not wear socks or knee-high stockings that are too tight below your knee.

Wear shoes that fit well. Shop for shoes at the end of the day when your feet are bigger. Break in shoes slowly. Wear them 1 to 2 hours each day for the first few weeks.

Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.

How can my doctor help me take care of my feet?

Tell your doctor right away about any foot problems.

Your doctor should do a complete foot exam every year.

Ask your doctor to look at your feet at each diabetes checkup. To make sure your doctor checks your feet, take off your shoes and socks before your doctor comes into the room.

Take off your shoes and socks so your doctor will check your feet.

Ask your doctor to check how well the nerves in your feet sense feeling.

Ask your doctor to check how well blood is flowing to your legs and feet.

Ask your doctor to show you the best way to trim your toenails. Ask what lotion or cream to use on your legs and feet.

If you cannot cut your toenails or you have a foot problem, ask your doctor to send you to a foot doctor. A doctor who cares for feet is called a podiatrist.

What are common diabetes foot problems?

Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.

Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.

Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become infected.

Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.

A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.

Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.

Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.

Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.

Athlete’s foot is a fungus that causes itchiness, redness, and cracking of the skin. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.

Tell your doctor about any foot problem as soon as you see it.

How can special shoes help my feet?

Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Medicare and other health insurance programs may pay for special shoes. Talk with your doctor about how and where to get them.

How can diabetes hurt my skin?

Diabetes can hurt your skin in two ways:

If your blood glucose is high, your body loses fluid. With less fluid in your body, your skin can get dry. Dry skin can be itchy, causing you to scratch and make it sore. Also, dry skin can crack. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds germs and makes infections worse. You may get dry skin on your legs, feet, elbows, and other places on your body.

What can I do to take care of my skin?

After you wash with a mild soap, make sure you rinse and dry yourself well. Check places where water can hide, such as under the arms, under the breasts, between the legs, and between the toes.
Keep your skin moist by washing with a mild soap and using lotion or cream after you wash.

Keep your skin moist by using a lotion or cream after you wash. Ask your doctor to suggest one.

Drink lots of fluids, such as water, to keep your skin moist and healthy.

Check your skin after you wash. Make sure you have no dry, red, or sore spots that might lead to an infection.

Tell your doctor about any skin problems.

Eye ComplicationsDiabetes can cause eye problems and may lead to blindness. People with diabetes do have a higher risk of blindness than people without diabetes. Early detection and treatment of eye problems can save your sight.

Complications

Diabetes retinopathy – damage to the blood vessels in the retina (back of the eye).

Cataract – clouding of the eye lens.

Glaucoma – increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

Symptoms

There are none. The vision may not change until the disease becomes severe.

Things you need to know

70% of loss of vision or blindness in the United States from diabetes retinopathy.

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Diabetic Retinopathy Defined

What is diabetic eye disease?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:

Diabetic retinopathy—damage to the blood vessels in the retina.

Cataract—clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.

Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

What is diabetic retinopathy?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

What are the stages of diabetic retinopathy?

Diabetic retinopathy has four stages:

Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.

Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.

Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Causes and Risk Factors

How does diabetic retinopathy cause vision loss?

Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.

Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

Who is at risk for diabetic retinopathy?

All people with diabetes--both type 1 and type 2--are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

What can I do to protect my vision?

If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:

Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.

Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.

You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.

Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.

The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.

This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

Symptoms and Detection

Does diabetic retinopathy have any symptoms?

Often there are no symptoms in the early stages of the disease, nor is there any pain. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.

Blurred vision may occur when the macula—the part of the retina that provides sharp central vision—swells from leaking fluid. This condition is called macular edema.

If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.

What are the symptoms of proliferative retinopathy if bleeding occurs?

At first, you will see a few specks of blood, or spots, "floating" in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.

Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.

How are diabetic retinopathy and macular edema detected?

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes:

Visual acuity test. This eye chart test measures how well you see at various distances.

Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional checks your retina for early signs of the disease, including:

Leaking blood vessels.

Retinal swelling (macular edema).

Pale, fatty deposits on the retina--signs of leaking blood vessels.

Damaged nerve tissue.

Any changes to the blood vessels.

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

Treatment

How is diabetic retinopathy treated?

During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.

Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

How is a macular edema treated?

Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.

Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss.

What happens during laser treatment?

Both focal and scatter laser treatment are performed in your doctor's office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.
Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

What is a vitrectomy?

If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.

A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.

You will probably be able to return home after the vitrectomy. Some people stay in the hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eyedrops to protect against infection.

Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure diabetic retinopathy.

Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.

What can I do if I already have lost some vision from diabetic retinopathy?

If you have lost some sight from diabetic retinopathy, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.

Skin ComplicationsYour body loses of fluids through frequent urination. This loss of fluids (dehydration) will make your skin and body dry. In fact, such problems are sometimes the first sign that a person has diabetes. It can damage nerves that produce oil and can make your body sweat less. Your skin relies on oil and sweat to keep it moist so the loss of oil and sweat can make it dry.

Complications

Dry skin cracks easily, letting germs enter.

Easily infected: Infections spread faster.

Infections are harder to treat

Infections take longer to heal.

Symptoms

Extra dry skin

Rashes

Itchy skin

Boils

Pimples

Things you need to know

Itchy skin in the vaginal, groin or foot areas may indicate an infection.

DepressionFeeling down once in a while is normal. But some people feel a sadness that just won't go away. Life seems hopeless. Feeling this way most of the day for two weeks or more is a sign of serious depression. That is why you choose Hope Diabetes Center as your diabetes care provider. Because taking care of your diabetes was a 24/7 job filled with responsibility and worries, Hope Diabetes Center created a program that will make your diabetes care easy to control. We understand that your emotional adjustment to diabetes is the key to good self-care and a long healthy life.

Complications

Stress can trigger a downward spiral on your health and high blood sugar.

alcohol or drug abuse

thyroid problems

side effects from some medications

Symptoms

Loss of pleasure You no longer take interest in doing things you used to enjoy.

Change in sleep patterns You have trouble falling asleep, you wake often during the night, or you want to sleep more than usual, including during the day.

Early to rise You wake up earlier than usual and cannot to get back to sleep.

Change in appetite You eat more or less than you used to, resulting in a quick weight gain or weight loss.

Trouble concentrating You can't watch a TV program or read an article because other thoughts or feelings get in the way.

Loss of energy You feel tired all the time.

Nervousness You always feel so anxious you can't sit still.

Guilt You feel you "never do anything right" and worry that you are a burden to others.

Morning sadness You feel worse in the morning than you do the rest of the day.

Suicidal thoughts You feel you want to die or are thinking about ways to hurt yourself.

Things you need to know

Stress of being sick may cause your blood sugar level to go higher.

Oral Health and HygieneThere are more bacteria in your mouth right now than there are people on Earth. If those germs settle into your gums, you've got gum disease. "Not me?" you say.

Complications

Yeast infection (white spot on the tongue)

Gingivitis – first stage of gums disease, redness around the gums, swelling and pain.

What are diabetes problems?

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

High blood glucose can cause tooth and gum problems.

This information is about the tooth and gum problems caused by diabetes. You will learn what you can do each day and during each year to stay healthy and prevent diabetes problems.

How can diabetes hurt my teeth and gums?

Tooth and gum problems can happen to anyone. A sticky film full of germs, called plaque, builds up on your teeth. High blood glucose helps germs, also called bacteria, grow. Then you can get red, sore, and swollen gums that bleed when you brush your teeth.

People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose can make tooth and gum problems worse. You can even lose your teeth.
Smoking makes it more likely for you to get a bad case of gum disease, especially if you have diabetes and are age 45 or older.

Red, sore, and bleeding gums are the first sign of gum disease. These problems can lead to periodontitis. Periodontitis is an infection in the gums and the bone that holds the teeth in place. If the infection gets worse, your gums may pull away from your teeth, making your teeth look long.
Call your dentist if you think you have problems with your teeth or gums.
Check your teeth and gums for signs of problems from diabetes.

How do I know if I have damage to my teeth and gums?

If you have one or more of these problems, you may have tooth and gum damage from diabetes:

red, sore, swollen gums

bleeding gums

gums pulling away from your teeth so your teeth look long

loose or sensitive teeth

bad breath

a bite that feels different

dentures—false teeth—that do not fit well

How can I keep my teeth and gums healthy?

Keep your blood glucose as close to normal as possible.

Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.

Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.

Brush and floss your teeth every day.

If you wear false teeth, keep them clean.

Call your dentist right away if you have problems with your teeth and gums.

Call your dentist if you have red, sore, or bleeding gums; gums that are pulling away from your teeth; a sore tooth that could be infected; or soreness from your dentures.

If your dentist tells you about a problem, take care of it right away.

Be sure your dentist knows that you have diabetes.

If you smoke, talk with your doctor about ways to quit smoking.

How can my dentist take care of my teeth and gums?

Your dentist can help you take care of your teeth and gums by

cleaning and checking your teeth twice a year

helping you learn the best way to brush and floss your teeth

telling you if you have problems with your teeth or gums and what to do about them

making sure your false teeth fit well

Get your teeth cleaned and checked twice a year.

Plan ahead. You may be taking a diabetes medicine that can cause low blood glucose, also called hypoglycemia. Talk with your doctor and dentist before the visit about the best way to take care of your blood glucose during the dental work. You may need to bring some diabetes medicine and food with you to the dentist’s office.

If your mouth is sore after the dental work, you might not be able to eat or chew for several hours or days. For guidance on how to adjust your normal routine while your mouth is healing, ask your doctor

what foods and drinks you should have

how you should change your diabetes medicines

how often you should check your blood glucose

Diabetes Vocabulary Here are some terms related to diabetes that I hope come in handy.

A1C - A test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.

Acanthosis nigricans (uh-kan-THO-sis NIH-grih-kans)
a skin condition characterized by darkened skin patches; common in people whose body is not responding correctly to the insulin that they make in their pancreas (insulin resistance). This skin condition is also seen in people who have pre-diabetes or Type II diabetes. Acanthosis nigricans is often associated with conditions that increase your insulin level, such as type II diabetes or being overweight. If your insulin level is too high, the extra insulin may trigger activity in your skin cells. This may cause the characteristic skin changes.

In some cases, acanthosis nigricans is inherited. Certain medications — such as oral contraceptives and large doses of niacin — can contribute to the condition. Other hormone problems, endocrine disorders or tumors may play a role as well. Rarely, acanthosis nigricans is associated with certain types of cancer.

Adhesive capsulitis (ad-HEE-sive cap-soo-LITE-is)
a condition of the shoulder associated with diabetes that results in pain and loss of the ability to move the shoulder in all directions.

AGEs (A-G-EEZ)
stands for advanced glycosylation (gly-KOH-sih-LAY-shun) end products. AGEs are produced in the body when glucose links with protein. They play a role in damaging blood vessels, which can lead to diabetes complications.

Albuminuria (al-BYOO-mih-NOO-ree-uh)
a condition in which the urine has more than normal amounts of a protein called albumin. Albuminuria may be a sign of nephropathy (kidney disease).

Alpha cell (AL-fa)
a type of cell in the pancreas. Alpha cells make and release a hormone called glucagon. The body sends a signal to the alpha cells to make glucagon when blood glucose falls too low. Then glucagon reaches the liver where it tells it to release glucose into the blood for energy.

Amylin (AM-ih-lin)
a hormone formed by beta cells in the pancreas. Amylin regulates the timing of glucose release into the bloodstream after eating by slowing the emptying of the stomach.

Amyotrophy (a-my-AH-truh-fee)
a Type of neuropathy resulting in pain, weakness and/or wasting in the muscles.

Anemia (uh-NEE-mee-uh)
a condition in which the number of red blood cells is less than normal, resulting in less oxygen being carried to the body's cells.

Antibodies (AN-ti-bod-eez)
proteins made by the body to protect itself from "foreign" substances such as bacteria or viruses. People get Type I diabetes when their bodies make antibodies that destroy the body's own insulin-making beta cells.

Arteriosclerosis (ar-TEER-ee-oh-skluh-RO-sis)
hardening of the arteries.

Artery a large blood vessel that carries blood with oxygen from the heart to all parts of the body.

Atherosclerosis (ATH-uh-row-skluh-RO-sis)
clogging, narrowing and hardening of the body's large arteries and medium-sized blood vessels. Atherosclerosis can lead to stroke, heart attack, eye problems and kidney problems.

Autoimmune disease (AW-toh-ih-MYOON)
disorder of the body's immune system in which the immune system mistakenly attacks and destroys body tissue that it believes to be foreign.

Background retinopathy (REH-tih-NOP-uh-thee)
a type of damage to the retina of the eye marked by bleeding, fluid accumulation and abnormal dilation of the blood vessels. Background retinopathy is an early stage of diabetic retinopathy. Also called simple or nonproliferative (non-pro-LIF-er-uh-tiv) retinopathy.

Blood pressure the force of blood exerted on the inside walls of blood vessels. Blood pressure is expressed as a ratio (example: 120/80, read as "120 over 80"). The first number is the systolic (sis-TAH-lik) pressure, or the pressure when the heart pushes blood out into the arteries. The second number is the diastolic (DY-uh-STAH-lik) pressure, or the pressure when the heart rests.

Blood urea nitrogen (BUN) (yoo-REE-uh NY-truh-jen)
a waste product in the blood from the breakdown of protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN levels increase.
blood vessels
tubes that carry blood to and from all parts of the body. The three main types of blood vessels are arteries, veins and capillaries.

Body mass index (BMI)
a measure used to evaluate body weight relative to a person's height. BMI is used to find out if a person is underweight, normal weight, overweight or obese.

Bolus (BOH-lus)
an extra amount of insulin taken to cover an expected rise in blood glucose, often related to a meal or snack.

Borderline diabetes a former term for Type 2 diabetes or impaired glucose tolerance.

Brittle diabetes a term used when a person's blood glucose level moves often from low to high and from high to low.

Bunion (BUN-yun)
a bulge on the first joint of the big toe, caused by the swelling of a fluid sac under the skin. This spot can become red, sore and infected.

C-peptide (see-peptide)
"Connecting peptide," a substance the pancreas releases into the bloodstream in equal amounts to insulin. A test of C-peptide levels shows how much insulin the body is making.

Callus a small area of skin, usually on the foot, that has become thick and hard from rubbing or pressure.

Calorie a unit representing the energy provided by food. Carbohydrate, protein, fat and alcohol provide calories in the diet. Carbohydrate and protein have 4 calories per gram, fat has 9 calories per gram, and alcohol has 7 calories per gram.

Capillary (KAP-ih-lair-ee)
the smallest of the body's blood vessels. Oxygen and glucose pass through capillary walls and enter the cells. Waste products such as carbon dioxide pass back from the cells into the blood through capillaries.

capsaicin (kap-SAY-ih-sin)
an ingredient in hot peppers that can be found in ointment form for use on the skin to relieve pain from diabetic neuropathy.

Carbohydrate (kar-boh-HY-drate)
one of the three main nutrients in food. Foods that provide carbohydrate are starches, vegetables, fruits, dairy products and sugars.

Dysphagia — difficulty swallowing

Dawn Syndrome – was salts from a nighttime release of growth hormone that causes blood glucose elevations at about five to 6 AM.

Cardiologist (kar-dee-AH-luh-jist)
a doctor who treats people who have heart problems.

Cardiometabolic risk factors (CAR-dee-oh MET-ah-BALL-ick)
a set of conditions that have a big effect on whether or not you develop diabetes or heart disease.

Cerebrovascular disease (seh-REE-broh-VASK-yoo-ler)
damage to blood vessels in the brain. Vessels can burst and bleed or become clogged with fatty deposits. When blood flow is interrupted, brain cells die or are damaged, resulting in a stroke.

Certified diabetes educator (CDE)
a health care professional with expertise in diabetes education who has met eligibility requirements and successfully completed a certification exam.

Charcot's foot (shar-KOHZ)
a condition in which the joints and soft tissue in the foot are destroyed; it results from damage to the nerves.

Cholesterol (koh-LES-ter-all)
a type of fat produced by the liver and found in the blood; it is also found in some foods. Cholesterol is used by the body to make hormones and build cell walls.

Chronic describes something that is long-lasting. Opposite of acute.

Circulation the flow of blood through the body's blood vessels and heart.

Coma a sleep-like state in which a person is not conscious. May be caused by hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose) in people with diabetes.

Complications harmful effects of diabetes such as damage to the eyes, heart, blood vessels, nervous system, teeth and gums, feet and skin, or kidneys. Studies show that keeping blood glucose, blood pressure, and low-density lipoprotein cholesterol levels close to normal can help prevent or delay these problems.

Congenital defects (kun-JEN-ih-tul)
problems or conditions that are present at birth.

Congestive heart failure loss of the heart's pumping power, which causes fluids to collect in the body, especially in the feet and lungs.

Coronary heart disease (KOR-uh-ner-ee)
heart disease caused by narrowing of the arteries that supply blood to the heart. If the blood supply is cut off, the result is a heart attack.

Creatinine (kree-AT-ih-nin)
a waste product from protein in the diet and from the muscles of the body. Creatinine is removed from the body by the kidneys; as kidney disease progresses, the level of creatinine in the blood increases.

Dehydration (dee-hy-DRAY-shun)
the loss of too much body fluid through frequent urinating, sweating, diarrhea or vomiting.

Dermopathy (dur-MAH-puh-thee)
disease of the skin.

Desensitization (dee-sens-ih-tiz-A-shun)
a way to reduce or stop a response such as an allergic reaction to something. For example, if someone has an allergic reaction to something, the doctor gives the person a very small amount of the substance at first to increase one's tolerance. Over a period of time, larger doses are given until the person is taking the full dose. This is one way to help the body get used to the full dose and to prevent the allergic reaction.

Dextrose, also called glucose (DECKS-trohss)
simple sugar found in blood that serves as the body's main source of energy.

Diabetes insipidus (in-SIP-ih-dus)
a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal.

Diabetes mellitus (MELL-ih-tus)
a condition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy. In Type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In Type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly.

Diabetic diarrhea (dy-uh-REE-uh)
loose stools, fecal incontinence, or both that result from an overgrowth of bacteria in the small intestine and diabetic neuropathy in the intestines. This nerve damage can also result in constipation.

Diabetic ketoacidosis (DKA) (KEY-toe-ass-ih-DOH-sis)
an emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of DKA are nausea and vomiting, stomach pain, fruity breath odor and rapid breathing. Untreated DKA can lead to coma and death.

Diabetic mastopathy a rare fibrous breast condition occurring in women, and sometimes men, with long-standing diabetes. The lumps are not malignant and can be surgically removed, although they often recur.

Diabetic myelopathy (my-eh-LAH-puh-thee)
damage to the spinal cord found in some people with diabetes.

Diabetic retinopathy (REH-tih-NOP-uh-thee)
diabetic eye disease; damage to the small blood vessels in the retina. Loss of vision may result.

Diabetologist (DY-uh-beh-TAH-luh-jist)
a doctor who specializes in treating people with diabetes.

Diagnosis (DY-ug-NO-sis)
the determination of a disease from its signs and symptoms.

Dialysis (dy-AL-ih-sis)
the process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.

Dietitian (DY-eh-TIH-shun)
a health care professional who advises people about meal planning, weight control and diabetes management. A registered dietitian (RD) has more training

Dilated eye exam (DY-lay-ted)
a test done by an eye care specialist in which the pupil (the black center) of the eye is temporarily enlarged with eyedrops to allow the specialist to see the inside of the eye more easily.

Dupuytren's contracture (doo-PWEE-trenz kon-TRACK-chur)
a condition associated with diabetes in which the fingers and the palm of the hand thicken and shorten, causing the fingers to curve inward.

Edema (eh-DEE-muh)
swelling caused by excess fluid in the body.

Electromyography (EMG) (ee-LEK-troh-my-AH-gruh-fee)
a test used to detect nerve function. It measures the electrical activity generated by muscles.

Endocrine gland (EN-doh-krin)
a group of specialized cells that release hormones into the blood. For example, the islets in the pancreas, which secrete insulin, are endocrine glands.

Endocrinologist (EN-doh-krih-NAH-luh-jist)
a doctor who treats people who have endocrine gland problems such as diabetes.

Enzyme (EN-zime)
protein made by the body that brings about a chemical reaction, for example, the enzymes produced by the gut to aid digestion.

Euglycemia (you-gly-SEEM-ee-uh)
a normal level of glucose in the blood.

Fasting plasma glucose (FPG) test
a check of a person's blood glucose level after the person has not eaten for 8 to 12 hours (usually overnight). This test is used to diagnose pre-diabetes and diabetes. It is also used to monitor people with diabetes.

Fat one of the three main nutrients in food. Foods that provide fat are butter, margarine, salad dressing, oil, nuts, meat, poultry, fish and some dairy products. 2. Excess calories are stored as body fat, providing the body with a reserve supply of energy and other functions.

Fluorescein angiography (fluh-RESS-ee-in an-gee-AH-grah-fee)
a test to examine blood vessels in the eye; done by injecting dye into an arm vein and then taking photos as the dye goes through the eye's blood vessels.

Fructosamine test (frook-TOH-sah-meen)
measures the number of blood glucose molecules (MAH-leh-kyools) linked to protein molecules in the blood. The test provides information on the average blood glucose level for the past 3 weeks.

Fructose (FROOK-tohss)
a sugar that occurs naturally in fruits and honey. Fructose has 4 calories per gram.

Gangrene (GANG-green)
the death of body tissue, most often caused by a lack of blood flow and infection. It can lead to amputation.

Gastroparesis (gas-tro-puh-REE-sis)
a form of neuropathy that affects the stomach. Digestion of food may be incomplete or delayed, resulting in nausea, vomiting, or bloating, making blood glucose control difficult.

Gestational diabetes mellitus (GDM) (jes-TAY-shun-ul MELL-ih-tus)
a type of diabetes mellitus that develops only during pregnancy and usually disappears upon delivery, but increases the risk that the mother will develop diabetes later. GDM is managed with meal planning, activity, and, in some cases, insulin.

Gingivitis (JIN-jih-VY-tis)
a condition of the gums characterized by inflammation and bleeding.

Glomerulus (glo-MEHR-yoo-lus)
a tiny set of looping blood vessels in the kidney where the blood is filtered and waste products are removed.

Glucagon (GLOO-kah-gahn)
a hormone produced by the alpha cells in the pancreas. It raises blood glucose. An injectable form of glucagon, available by prescription, may be used to treat severe hypoglycemia.
glucose
one of the simplest forms of sugar.

Glucose tablets chewable tablets made of pure glucose used for treating hypoglycemia.

Glycemic index (gly-SEE-mik)
a ranking of carbohydrate-containing foods, based on the food's effect on blood glucose compared with a standard reference food.

Glycogen (GLY-koh-jen)
the form of glucose found in the liver and muscles.

Glycosuria (gly-koh-SOOR-ee-ah)
the presence of glucose in the urine.

Gram a unit of weight in the metric system. An ounce equals 28 grams. In some meal plans for people with diabetes, the suggested amounts of food are given in grams.

HDL cholesterol, stands for high-density-lipoprotein cholesterol (kuh-LESS-tuh-rawl LIP-oh-PRO-teen)
a fat found in the blood that takes extra cholesterol from the blood to the liver for removal. Sometimes called "good" cholesterol.

Heredity the passing of a trait from parent to child.

Honeymoon phase Some people with type 1 diabetes experience a brief remission called the "honeymoon period." During this time their pancreas may still secrete some insulin. Over time, this secretion stops and as this happens, the child will require more insulin from injections. The honeymoon period can last weeks, months, or even up to a year or more.

Hormone a chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. For example, insulin is a hormone made in the pancreas that tells other cells when to use glucose for energy. Synthetic hormones, made for use as medicines, can be the same or different from those made in the body.

Human leukocyte antigens (HLA)
proteins located on the surface of the cell that help the immune system identify the cell either as one belonging to the body or as one from outside the body. Some patterns of these proteins may mean increased risk of developing Type 1 diabetes.

Hyperglycemia (HY-per-gly-SEE-mee-uh)
excessive blood glucose. Fasting hyperglycemia is blood glucose above a desirable level after a person has fasted for at least 8 hours. Postprandial hyperglycemia is blood glucose above a desirable level 1 to 2 hours after a person has eaten.

Hyperinsulinemia (HY-per-IN-suh-lih-NEE-mee-uh)
a condition in which the level of insulin in the blood is higher than normal. Caused by overproduction of insulin by the body. Related to insulin resistance.

Hyperlipidemia (HY-per-li-pih-DEE-mee-uh)
higher than normal fat and cholesterol levels in the blood.

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) (HY-per-oz-MOH-lur HY-per-gly-SEE-mik non-kee-TAH-tik)
an emergency condition in which one's blood glucose level is very high and ketones are not present in the blood or urine. If HHNS is not treated, it can lead to coma or death.

Hypertension (HY-per-TEN-shun)
a condition present when blood flows through the blood vessels with a force greater than normal. Also called high blood pressure. Hypertension can strain the heart, damage blood vessels, and increase the risk of heart attack, stroke, kidney problems and death.

Hypoglycemia (hy-po-gly-SEE-mee-uh)
a condition that occurs when one's blood glucose is lower than normal, usually less than 70 mg/dL. Signs include hunger, nervousness, shakiness, perspiration, dizziness or light-headedness, sleepiness, and confusion. If left untreated, hypoglycemia may lead to unconsciousness. Hypoglycemia is treated by consuming a carbohydrate-rich food such as a glucose tablet or juice. It may also be treated with an injection of glucagon if the person is unconscious or unable to swallow. Also called an insulin reaction.

Hypoglycemia unawareness (un-uh-WARE-ness)
a state in which a person does not feel or recognize the symptoms of hypoglycemia. People who have frequent episodes of hypoglycemia may no longer experience the warning signs of it.

Hypotension (hy-poh-TEN-shun)
low blood pressure or a sudden drop in blood pressure. Hypotension may occur when a person rises quickly from a sitting or reclining position, causing dizziness or fainting.

IDDM (insulin-dependent diabetes mellitus)
former term for Type 1 diabetes.

Immune system (ih-MYOON)
the body's system for protecting itself from viruses and bacteria or any "foreign" substances.

Immunosuppressant (ih-MYOON-oh-suh-PRESS-unt)
a drug that suppresses the natural immune responses. Immunosuppressants are given to transplant patients to prevent organ rejection or to patients with autoimmune diseases.

Impaired fasting glucose (IFG) a condition in which a blood glucose test, taken after an 8- to 12-hour fast, shows a level of glucose higher than normal but not high enough for a diagnosis of diabetes. IFG, also called pre-diabetes, is a level of 100 mg/dL to 125 mg/dL. Most people with pre-diabetes are at increased risk for developing type 2 diabetes.

Impaired glucose tolerance (IGT) a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. IGT, also called pre-diabetes, is a level of 140 mg/dL to 199 mg/dL 2 hours after the start of an oral glucose tolerance test. Most people with pre-diabetes are at increased risk for developing type 2 diabetes. Other names for IGT that are no longer used are "borderline," "subclinical," "chemical," or "latent" diabetes.

Implantable insulin pump (im-PLAN-tuh-bull)
a small pump placed inside the body to deliver insulin in response to remote-control commands from the user.

Impotence (IM-po-tents)
the inability to get or maintain an erection for sexual activity. Also called erectile (ee-REK-tile) dysfunction (dis-FUNK-shun).

Incidence (IN-sih-dints)
a measure of how often a disease occurs; the number of new cases of a disease among a certain group of people for a certain period of time.

Incontinence (in-KON-tih-nents)
loss of bladder or bowel control; the accidental loss of urine or feces.
inhaled insulin
an experimental treatment for taking insulin using a portable device that allows a person to breathe in insulin.

Incidence (IN-sih-dints)
a measure of how often a disease occurs; the number of new cases of a disease among a certain group of people for a certain period of time.

Incontinence (in-KON-tih-nents)
loss of bladder or bowel control; the accidental loss of urine or feces.
inhaled insulin
an experimental treatment for taking insulin using a portable device that allows a person to breathe in insulin.

Injection (in-JEK-shun)
inserting liquid medication or nutrients into the body with a syringe. A person with diabetes may use short needles or pinch the skin and inject at an angle to avoid an intramuscular injection of insulin.

Injection site rotation changing the places on the body where insulin is injected. Rotation prevents the formation of lipodystrophies.

Injection sites places on the body where insulin is usually injected.

Insulin a hormone that helps the body use glucose for energy. The beta cells of the pancreas make insulin. When the body cannot make enough insulin, it is taken by injection or through use of an insulin pump.

Insulin adjustment a change in the amount of insulin a person with diabetes takes based on factors such as meal planning, activity and blood glucose levels.

Insulin analogues An insulin analogue is a tailored form of insulin in which certain amino acids in the insulin molecule have been modified. The analogue acts in the same way as the original insulin, but with some beneficial differences for people with diabetes. Analogues are sometimes referred to as "designer" insulins.

Insulin pen a device for injecting insulin that looks like a fountain pen and holds replaceable cartridges of insulin. Also available in disposable form.

Insulin pump an insulin-delivering device about the size of a deck of cards that can be worn on a belt or kept in a pocket. An insulin pump connects to narrow, flexible plastic tubing that ends with a needle inserted just under the skin. Users set the pump to give a steady trickle or basal amount of insulin continuously throughout the day. Pumps release bolus doses of insulin (several units at a time) at meals and at times when blood glucose is too high, based on programming done by the user.

Insulin reaction when the level of glucose in the blood is too low (at or below 70 mg/dL). Also known as hypoglycemia.

Insulin receptors areas on the outer part of a cell that allow the cell to bind with insulin in the blood. When the cell and insulin bind, the cell can take glucose from the blood and use it for energy.

Insulin resistance the body's inability to respond to and use the insulin it produces. Insulin resistance may be linked to obesity, hypertension, and high levels of fat in the blood.

Insulin-dependent diabetes mellitus (IDDM)
former term for Type 1 diabetes.

Insulinoma (IN-suh-lih-NOH-mah)
a tumor of the beta cells in the pancreas. An insulinoma may cause the body to make extra insulin, leading to hypoglycemia.

Intensive therapy a treatment for diabetes in which blood glucose is kept as close to normal as possible through frequent injections or use of an insulin pump; meal planning; adjustment of medicines; and exercise based on blood glucose test results and frequent contact with a person's health care team.

Intermediate-acting insulin a type of insulin that starts to lower blood glucose within 1 to 2 hours after injection and has its strongest effect 6 to 12 hours after injection, depending on the type used. See lente insulin and NPH insulin.

Intermittent claudication (IN-ter-MIT-ent CLAW-dih-KAY-shun)
pain that comes and goes in the muscles of the leg. This pain results from a lack of blood supply to the legs and usually happens when walking or exercising.

Intramuscular injection (in-trah-MUS-kyoo-lar)
inserting liquid medication into a muscle with a syringe. Glucagon may be given by subcutaneous or intramuscular injection for hypoglycemia.

Islet cell autoantibodies (ICA) (EYE-let aw-toe-AN-ti-bod-eez)
proteins found in the blood of people newly diagnosed with Type 1 diabetes. They are also found in people who may be developing Type 1 diabetes. The presence of ICA indicates that the body's immune system has been damaging beta cells in the pancreas.

Islet transplantation moving the islets from a donor pancreas into a person whose pancreas has stopped producing insulin. Beta cells in the islets make the insulin that the body needs for using blood glucose.
Islets groups of cells located in the pancreas that make hormones that help the body break down and use food. For example, alpha cells make glucagon and beta cells make insulin. Also called islets of Langerhans (LANG-er-hahns).

Jet injector (in-JEK-tur)
a device that uses high pressure instead of a needle to propel insulin through the skin and into the body.

Juvenile diabetes former term for insulin-dependent diabetes mellitus (IDDM), or Type 1 diabetes.

Ketone a chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy. High levels of ketones can lead to diabetic ketoacidosis and coma. Sometimes referred to as ketone bodies. Ketones are an acid remaining when the body burns its own fat. When the body has insufficient insulin, it cannot get glucose from the blood into the body's cells to use as energy and will instead begin to burn fat. When the body is burning too much fat, it may cause ketones to become present in the bloodstream

Ketonuria (key-toe-NUH-ree-ah)
a condition occurring when ketones are present in the urine, a warning sign of diabetic ketoacidosis.

Ketosis (ke-TOE-sis)
a ketone buildup in the body that may lead to diabetic ketoacidosis. Signs of ketosis are nausea, vomiting, and stomach pain.

Kidney failure a chronic condition in which the body retains fluid and harmful wastes build up because the kidneys no longer work properly. A person with kidney failure needs dialysis or a kidney transplant. Also called end-stage renal (REE-nul) disease or ESRD.

Kidneys the two bean-shaped organs that filter wastes from the blood and form urine. The kidneys are located near the middle of the back. They send urine to the bladder.

Kussmaul breathing (KOOS-mall)
the rapid, deep, and labored breathing of people who have diabetic ketoacidosis.

Lancet a spring-loaded device used to prick the skin with a small needle to obtain a drop of blood for blood glucose monitoring.

Laser surgery treatment a type of therapy that uses a strong beam of light to treat a damaged area. The beam of light is called a laser. A laser is sometimes used to seal blood vessels in the eye of a person with diabetes. See photocoagulation.

Latent autoimmune diabetes in adults (LADA)
a condition in which Type 1 diabetes develops in adults.

LDL cholesterol, stands for low-density lipoprotein cholesterol (kuh-LESS-tuh-rawl LIP-oh-PRO-teen)
a fat found in the blood that takes cholesterol around the body to where it is needed for cell repair and also deposits it on the inside of artery walls. Sometimes called "bad" cholesterol.

Lente insulin (LEN-tay)
an intermediate-acting insulin. On average, lente insulin starts to lower blood glucose levels within 1 to 2 hours after injection. It has its strongest effect 8 to 12 hours after injection but keeps working for 18 to 24 hours after injection. Also called L insulin.

Limited joint mobility a condition in which the joints swell and the skin of the hand becomes thick, tight, and waxy, making the joints less able to move. It may affect the fingers and arms as well as other joints in the body.

Lipid (LIP-id)
a term for fat in the body. Lipids can be broken down by the body and used for energy.

Lipid profile a blood test that measures total cholesterol, triglycerides, and HDL cholesterol. LDL cholesterol is then calculated from the results. A lipid profile is one measure of a person's risk of cardiovascular disease.

Lipoatrophy (LIP-oh-AT-ruh-fee)
loss of fat under the skin resulting in small dents. Lipoatrophy may be caused by repeated injections of insulin in the same spot.

Lipodystrophy (LIP-oh-DIH-struh-fee)
defect in the breaking down or building up of fat below the surface of the skin, resulting in lumps or small dents in the skin surface. (See lipohypertrophy or lipoatrophy.) Lipodystrophy may be caused by repeated injections of insulin in the same spot.

Lipohypertrophy (LIP-oh-hy-PER-truh-fee)
buildup of fat below the surface of the skin, causing lumps. Lipohypertrophy may be caused by repeated injections of insulin in the same spot.

Lispro insulin (LYZ-proh)
a rapid-acting insulin. On average, lispro insulin starts to lower blood glucose within 5 minutes after injection. It has its strongest effect 30 minutes to 1 hour after injection but keeps working for 3 hours after injection.

Liver an organ in the body that changes food into energy, removes alcohol and poisons from the blood, and makes bile, a substance that breaks down fats and helps rid the body of wastes.

Long-acting insulin a type of insulin that starts to lower blood glucose within 4 to 6 hours after injection and has its strongest effect 10 to 18 hours after injection. See ultralente insulin.

Macrosomia (mack-roh-SOH-mee-ah)
abnormally large; in diabetes, refers to abnormally large babies that may be born to women with diabetes.

Macrovascular disease (mack-roh-VASK-yoo-ler)
disease of the large blood vessels, such as those found in the heart. Lipids and blood clots build up in the large blood vessels and can cause atherosclerosis, coronary heart disease, stroke, and peripheral vascular disease.

Macula (MACK-yoo-la)
the part of the retina in the eye used for reading and seeing fine detail.

Macular edema (MACK-yoo-lur eh-DEE-mah)
swelling of the macula.

Mastopathy, diabetic a rare fibrous breast condition occurring in women, and sometimes men, with long-standing diabetes. The lumps are not malignant and can be surgically removed, although they often recur.

Maturity-onset diabetes of the young (MODY)
a kind of Type 2 diabetes that accounts for 1 to 5 percent of people with diabetes. Of the six forms identified, each is caused by a defect in a single gene.

Meglitinide (meh-GLIH-tin-ide)
a class of oral medicine for Type 2 diabetes that lowers blood glucose by helping the pancreas make more insulin right after meals. (Generic name: repaglinide)

Metabolic syndrome
the tendency of several conditions to occur together, including obesity, insulin resistance, diabetes or pre-diabetes, hypertension, and high lipids.

Metabolism the term for the way cells chemically change food so that it can be used to store or use energy and make the proteins, fats, and sugars needed by the body.

Metformin (met-FOR-min)
an oral medicine used to treat Type 2 diabetes. It lowers blood glucose by reducing the amount of glucose produced by the liver and helping the body respond better to the insulin made in the pancreas. Belongs to the class of medicines called biguanides. (Brand names: Glucophage, Glucophage XR; an ingredient in Glucovance)

mg/dL
milligrams (MILL-ih-grams) per deciliter (DESS-ih-lee-tur), a unit of measure that shows the concentration of a substance in a specific amount of fluid. In the United States, blood glucose test results are reported as mg/dL. Medical journals and other countries use millimoles per liter (mmol/L). To convert to mg/dL from mmol/L, multiply mmol/L by 18. Example: 10 mmol/L ? 18 = 180 mg/dL.

Microalbumin (MY-kro-al-BYOO-min)
small amounts of the protein called albumin in the urine detectable with a special lab test.

Microalbuminuria (MY-kro-al-BYOO-min-your-EE-ah)
the presence of small amounts of albumin, a protein, in the urine. Microalbuminuria is an early sign of kidney damage, or nephropathy, a common and serious complication of diabetes. The ADA recommends that people diagnosed with type 2 diabetes be tested for microalbuminuria at the time they are diagnosed and every year thereafter; people with type 1 diabetes should be tested 5 years after diagnosis and every year thereafter. Microalbuminuria is usally managed by improving blood glucose control, reducing blood pressure, and modifying the diet.

Microaneurysm (MY-kro-AN-yeh-rizm)
a small swelling that forms on the side of tiny blood vessels. These small swellings may break and allow blood to leak into nearby tissue. People with diabetes may get microaneurysms in the retina of the eye.

Microvascular disease (MY-kro-VASK-yoo-ler)
disease of the smallest blood vessels, such as those found in the eyes, nerves, and kidneys. The walls of the vessels become abnormally thick but weak. Then they bleed, leak protein, and slow the flow of blood to the cells.

Miglitol (MIG-lih-tall)
an oral medicine used to treat Type 2 diabetes. It blocks the enzymes that digest starches in food. The result is a slower and lower rise in blood glucose throughout the day, especially right after meals. Belongs to the class of medicines called alpha-glucosidase inhibitors. (Brand name: Glyset)

mixed dose
a combination of two types of insulin in one injection. Usually a rapid- or short-acting insulin is combined with a longer acting insulin (such as NPH insulin) to provide both short-term and long-term control of blood glucose levels.

mmol/L
millimoles per liter, a unit of measure that shows the concentration of a substance in a specific amount of fluid. In most of the world, except for the United States, blood glucose test results are reported as mmol/L. In the United States, milligrams per deciliter (mg/dL) is used. To convert to mmol/L from mg/dL, divide mg/dL by 18. Example: 180 mg/dL ? 18 = 10 mmol/L.

Monofilament a short piece of nylon, like a hairbrush bristle, mounted on a wand. To check sensitivity of the nerves in the foot, the doctor touches the filament to the bottom of the foot.

Myocardial infarction (my-oh-KAR-dee-ul in-FARK-shun)
an interruption in the blood supply to the heart because of narrowed or blocked blood vessels. Also called a heart attack.

Nateglinide (neh-TEH-glin-ide)
an oral medicine used to treat Type 2 diabetes. It lowers blood glucose levels by helping the pancreas make more insulin right after meals. Belongs to the class of medicines called D-phenylalanine derivatives. (Brand name: Starlix)

Necrobiosis lipoidica diabeticorum (NEK-roh-by-OH-sis lih-POY-dik-ah DY-uh-bet-ih-KOR-um)
a skin condition usually on the lower part of the legs. Lesions can be small or extend over a large area. They are usually raised, yellow, and waxy in appearance and often have a purple border.

Neovascularization (NEE-oh-VASK-yoo-ler-ih-ZAY-shun)
the growth of new, small blood vessels. In the retina, this may lead to loss of vision or blindness.

Nephrologist (neh-FRAH-luh-jist)
a doctor who treats people who have kidney problems.

Nephropathy (neh-FROP-uh-thee)
disease of the kidneys. Hyperglycemia and hypertension can damage the kidneys' glomeruli. When the kidneys are damaged, protein leaks out of the kidneys into the urine. Damaged kidneys can no longer remove waste and extra fluids from the bloodstream.

Nerve conduction studies tests used to measure for nerve damage; one way to diagnose neuropathy.

Neurologist (ne-RAH-luh-jist)
a doctor who specializes in problems of the nervous system, such as neuropathy.

Neuropathy (ne-ROP-uh-thee)
disease of the nervous system. The three major forms in people with diabetes are peripheral neuropathy, autonomic neuropathy, and mononeuropathy. The most common form is peripheral neuropathy, which affects mainly the legs and feet.

Noninsulin-dependent diabetes mellitus (NIDDM)
former term for Type 2 diabetes.

NPH insulin an intermediate-acting insulin; NPH stands for neutral protamine Hagedorn. On average, NPH insulin starts to lower blood glucose within 1 to 2 hours after injection. It has its strongest effect 6 to 10 hours after injection but keeps working about 10 hours after injection. Also called N insulin.

Nutritionist (noo-TRIH-shuh-nist)
a person with training in nutrition; may or may not have specialized training and qualifications. See dietitian.

Obesity a condition in which a greater than normal amount of fat is in the body; more severe than overweight; having a body mass index of 30 or more.

Oral glucose tolerance test (OGTT)
a test to diagnose pre-diabetes and diabetes. The oral glucose tolerance test is given by a health care professional after an overnight fast. A blood sample is taken, then the patient drinks a high-glucose beverage. Blood samples are taken at intervals for 2 to 3 hours. Test results are compared with a standard and show how the body uses glucose over time.

Oral hypoglycemic agents (hy-po-gly-SEE-mik)
medicines taken by mouth by people with Type 2 diabetes to keep blood glucose levels as close to normal as possible. Classes of oral hypoglycemic agents are alpha-glucosidase inhibitors, biguanides, D-phenylalanine derivatives, meglitinides, sulfonylureas, and thiazolidinediones.

Overweight an above-normal body weight; having a body mass index of 25 to 29.9.

pancreas (PAN-kree-us)
an organ that makes insulin and enzymes for digestion. The pancreas is located behind the lower part of the stomach and is about the size of a hand.

Pancreas transplantation a surgical procedure to take a healthy whole or partial pancreas from a donor and place it into a person with diabetes.

Pediatric endocrinologist (pee-dee-AT-rik en-doh-krih-NAH-luh-jist)
a doctor who treats children who have endocrine gland problems such as diabetes.

Pedorthist (ped-OR-thist)
a health care professional who specializes in fitting shoes for people with disabilities or deformities. A pedorthist can custom-make shoes or orthotics (special inserts for shoes).

Periodontal disease (PER-ee-oh-DON-tul)
disease of the gums.

Periodontist (PER-ee-oh-DON-tist)
a dentist who specializes in treating people who have gum diseases.

Peripheral vascular disease (PVD) (puh-RIF-uh-rul VAS-kyoo-ler)
a disease of the large blood vessels of the arms, legs, and feet. PVD may occur when major blood vessels in these areas are blocked and do not receive enough blood. The signs of PVD are aching pains and slow-healing foot sores.

Pharmacist (FAR-mah-sist)
a health care professional who prepares and distributes medicine to people. Pharmacists also give information on medicines.

Photocoagulation (FOH-toh-koh-ag-yoo-LAY-shun)
a treatment for diabetic retinopathy. A strong beam of light (laser) is used to seal off bleeding blood vessels in the eye and to burn away extra blood vessels that should not have grown there.

Pioglitazone (py-oh-GLIT-uh-zone)
an oral medicine used to treat Type 2 diabetes. It helps insulin take glucose from the blood into the cells for energy by making cells more sensitive to insulin. Belongs to the class of medicines called thiazolidinediones. (Brand name: Actos)

Podiatrist (puh-DY-uh-trist)
a doctor who treats people who have foot problems. Podiatrists also help people keep their feet healthy by providing regular foot examinations and treatment.

Podiatry (puh-DY-uh-tree)
the care and treatment of feet.

Point system a meal planning system that uses points to rate the caloric content of foods.

Polydipsia (pah-lee-DIP-see-uh)
excessive thirst; may be a sign of diabetes.

Polyphagia (pah-lee-FAY-jee-ah)
excessive hunger; may be a sign of diabetes.

Polyuria (pah-lee-YOOR-ee-ah)
excessive urination; may be a sign of diabetes.

Pre-diabetes a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are Type 2 diabetics. Other names for pre-diabetes are impaired glucose tolerance and impaired fasting glucose.
Preprandial blood glucose (pree-PRAN-dee-ul)
the blood glucose level taken before eating.

Prevalence the number of people in a given group or population who are reported to have a disease.

Proinsulin (proh-IN-suh-lin)
the substance made first in the pancreas and then broken into several pieces to become insulin.

Proliferative retinopathy (pro-LIH-fur-ah-tiv REH-tih-NOP-uh-thee)
a condition in which fragile new blood vessels grow along the retina and in the vitreous humor of the eye.

Prosthesis (prahs-THEE-sis)
a man-made substitute for a missing body part such as an arm or a leg.

Protein (PRO-teen)
1. One of the three main nutrients in food. Foods that provide protein include meat, poultry, fish, cheese, milk, dairy products, eggs, and dried beans. 2. Proteins are also used in the body for cell structure, hormones such as insulin, and other functions.

Proteinuria (PRO-tee-NOOR-ee-uh)
the presence of protein in the urine, indicating that the kidneys are not working properly.

Rebound hyperglycemia (HY-per-gly-SEE-mee-ah)
a swing to a high level of glucose in the blood after a low level. See Somogyi effect.

Renal (REE-nal)
having to do with the kidneys. A renal disease is a disease of the kidneys. Renal failure means the kidneys have stopped working.

Renal threshold of glucose (THRESH-hold)
the blood glucose concentration at which the kidneys start to excrete glucose into the urine.

Repaglinide (reh-PAG-lih-nide)
an oral medicine used to treat Type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin right after meals. Belongs to the class of medicines called meglitinides. (Brand name: Prandin)

Retina (REH-ti-nuh)
the light-sensitive layer of tissue that lines the back of the eye.

Retinopathy (REH-tih-NOP-uh-thee)
Eye disease that is caused by damage to the small blood vessels in the retina. Loss of vision may result. (Also known as diabetic retinopathy)

Risk factor anything that raises the chances of a person developing a disease.

Somogyi effect, also called rebound hyperglycemia (suh-MOH-jee)
when the blood glucose level swings high following hypoglycemia. The Somogyi effect may follow an untreated hypoglycemic episode during the night and is caused by the release of stress hormones.

Sorbitol (SORE-bih-tall)
1. A sugar alcohol (sweetener) with 2.6 calories per gram. 2. A substance produced by the body in people with diabetes that can cause damage to the eyes and nerves.

Starch another name for carbohydrate, one of the three main nutrients in food.

Stroke condition caused by damage to blood vessels in the brain; may cause loss of ability to speak or to move parts of the body.

Subcutaneous injection (sub-kyoo-TAY-nee-us)
putting a fluid into the tissue under the skin with a needle and syringe.

Sucralose a sweetener made from sugar but with no calories and no nutritional value.

Sucrose a two-part sugar made of glucose and fructose. Known as table sugar or white sugar, it is found naturally in sugar cane and in beets.

Sugar
1. A class of carbohydrates with a sweet taste, including glucose, fructose and sucrose. 2. A term used to refer to blood glucose.

Sugar alcohols sweeteners that produce a smaller rise in blood glucose than other carbohydrates. Their calorie content is about 2 calories per gram. Includes erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. Also known as polyols (PAH-lee-alls.)

Sulfonylurea (sul-fah-nil-yoo-REE-ah)
a class of oral medicine for Type II diabetes that lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. (Generic names: acetohexamide, chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, tolbutamide)

Triglyceride (try-GLISS-er-ide)
the storage form of fat in the body. High triglyceride levels may occur when diabetes is out of control.

Type I diabetes a condition characterized by high blood glucose levels caused by a total lack of insulin. Occurs when the body's immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Type I diabetes develops most often in young people but can appear in adults.
Type II diabetes a condition characterized by high blood glucose levels caused by either a lack of insulin or the body's inability to use insulin efficiently. Type II diabetes develops most often in middle-aged and older adults but can appear in young people.

Ulcer (UL-sur)
a deep open sore or break in the skin.

Ultralente insulin (UL-truh-LEN-tay)
long-acting insulin. On average, ultralente insulin starts to lower blood glucose within 4 to 6 hours after injection. It has its strongest effect 10 to 18 hours after injection but keeps working 24 to 28 hours after injection. Also called U insulin.

Unit of insulin the basic measure of insulin. U-100 insulin means 100 units of insulin per milliliter (mL) or cubic centimeter (cc) of solution. Most insulin made today in the United States is U-100.

United Kingdom Prospective Diabetes Study (UKPDS)
a study in England, conducted from 1977 to 1997 in people with Type 2 diabetes. The study showed that if people lowered their blood glucose, they lowered their risk of eye disease and kidney damage. In addition, those with Type 2 diabetes and hypertension who lowered their blood pressure also reduced their risk of stroke, eye damage, and death from long-term complications.

Urea (yoo-REE-uh)
a waste product found in the blood that results from the normal breakdown of protein in the liver. Urea is normally removed from the blood by the kidneys and then excreted in the urine.

Uremia (yoo-REE-mee-ah)
the illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion.

Urine the liquid waste product filtered from the blood by the kidneys, stored in the bladder, and expelled from the body by the act of urinating.

Urine testing also called urinalysis; a test of a urine sample to diagnose diseases of the urinary system and other body systems. Urine may also be checked for signs of bleeding. Some tests use a single urine sample. For others, 24-hour collection may be needed. And sometimes a sample is "cultured" to see exactly what type of bacteria grows.

Urologist (yoo-RAH-luh-jist)
a doctor who treats people who have urinary tract problems. A urologist also cares for men who have problems with their genital organs, such as impotence.

Vascular (VAS-kyoo-ler)
relating to the body's blood vessels.

Vein a blood vessel that carries blood to the heart.

Very-low-density lipoprotein (VLDL) cholesterol
a form of cholesterol in the blood; high levels may be related to cardiovascular disease.

Vitrectomy (vih-TREK-tuh-mee)
surgery to restore sight in which the surgeon removes the cloudy vitreous humor in the eye and replaces it with a salt solution.

Vitreous humor (VIH-tree-us)
the clear gel that lies behind the eye's lens and in front of the retina.
void
to urinate; to empty the bladder.

Xylitol (ZY-lih-tall)
a carbohydrate-based sweetener found in plants and used as a substitute for sugar; provides calories. Found in some mints and chewing gum.